Dr. Vijay Kumar Malhotra

Nephrotic syndrome is a type of kidney disorder wherein, the body passes out the excess amount of proteins through urine, owing to the damage caused to the tiny clusters of blood vessels in the kidneys. The symptoms include putting on excessive weight as a result of fluid retention, foamy urine and severe swelling around the region of the feet, ankles and eyes. 

The main feature of nephrotic syndrome is that the kidneys leak a lot of protein. Normally, urine contains virtually no protein. In nephrotic syndrome the urine contains large amounts of protein. What happens is that filters in the kidneys (the glomeruli) become 'leaky' and protein, instead of remaining in the blood, leaks out into the urine. Protein in the urine is called proteinuria. 

The other key features of nephrotic syndrome are: 

1. A low level of protein in the blood as a result of protein loss in the urine. Although there is a drop in many of the proteins normally found in the bloodstream, the main protein that leaks from the blood into the urine is called albumin. A low blood level of albumin is main feature of nephrotic syndrome. 
2. Fluid retention (oedema). This is a consequence of the low level of albumin in the bloodstream, and other complex factors not fully understood. 
3. A high blood level of cholesterol and other fats (lipids). This is due to the change in the balance of various protein levels in the blood due to the protein leakage. 
4. Normal kidney function, at least initially. This means that the 'waste clearing' function of the kidneys is not affected - at least not at first. However, some of the conditions that cause nephrotic syndrome can progress to cause chronic kidney disease. 
5. Other typical symptoms and signs of nephrotic syndrome are discussed later. 

Common causes behind it 

Minimal change disease (also known as nil disease) leads to the abnormal functioning of the kidneys.. Most common cause almost 90% of children have this entity. No body knows why the Minimal change disease nephrotic syndrome occurs. Other reasons for nephrotic syndrome are infections, autoimmunity mediated and few medications. 

Nephrotic syndrome (NS) is the name given to a collection of kidney-related findings in your child’s body. These include: 

1. proteinuria—high levels of protein in the urine (based on your child’s age and size) 
2. hypoalbuminemia—low levels of protein in your child’s blood, since it’s being passed out of his body in his urine 
3. edema—swelling. This happens because the proteins in your child’s blood act as a sponge to keep fluid in the blood. With fewer proteins to do this, the fluid may leak out of the blood into your child’s tissues, causing them to swell, especially around the stomach area.
4. high cholesterol (blood fat) levels—low levels of protein in the blood stimulate the body to overproduce certain kinds of blood fats
5. While nephrotic syndrome is not a disease, it can be the first sign of disease that can damage the kidney's tiny blood-filtering unit (glomeruli) where urine is made. 

Here’s what you need to know about nephrotic syndrome: 

1. In the vast majority of children, NS is idiopathic, meaning that doctors don’t yet know what causes it. 
2. Nephrotic syndrome always affects both kidneys. 
3. It usually appears between the toddler and elementary school years, although it may appear later. 
4. There are thought to be two forms of nephrotic syndrome, minimal change disease (MCD) and focal sclerosis (FSGS). 
5. MCD is much more common in children, and likely to respond to therapy. 
6. FSGS is a more aggressive disease, and may lead to kidney damage. 
7. Most children with NS outgrow it by young adulthood. 

Treatment Available 

Pediatric Nephrotic syndrome is mainly treated by high dose steroids. So we classify Nephrotic syndrome as Steroid sensitive Nephrotic syndrome and Steroid Resistant Nephrotic syndrome. As long as the Nephrotic syndrome is steroid sensitive, kidneys usually do not fail and eventually the child recovers. Other aspect of management of Nephrotic syndrome in kids is, that is a relapsing and remitting disease in more than 2/3 of patients, so parents must be making a Nephrotic diary as suggested by the doctor so that the relapse of disease is picked before the swelling appears. Target of Nephrotic syndrome treatment is to make the child grow normally and using steroid sparing agents in kids with frequent relapses and Steroid dependence else they can develop high blood pressure, short stature, cataract, glaucoma and diabetes which all are irreversible. Never start or stop the steroids on your own considering the side effect profile. All vaccines including oral polio drops are not to be given in children receiving daily dose steroids. If you wish to discuss about any specific problem, you can consult a pediatrician.

The journey to parenthood begins long before the baby arrives, long before the expectant parents ever set eyes on the new life they have created. Being a parent is hard and exhausting, mentally, physically and emotionally. As a mother, one goes through a journey that encompasses huge changes to her body, her emotional state of mind, career, relationship with partner and her entire outlook on the world around her but, let's not forget the emotional impact on fathers too.

There is no, particular psychological pathway to parenthood as every couple's experience is shaped by a unique set of circumstances; their own childhood memories of their parents, observations of other parents and by the type of relationship they have with each other.

Being parents changes you: Becoming a parent changes two fundamental things: first, your perception about yourself, and secondly, it changes the nature of your relationship with your partner. You need to understand that you're no longer two independent adults but a team. You have to prioritize the needs of your child over and above your own needs. The sooner you realize and implement this in your life, the better you turn out as a parent.

Planning is essential: As an expectant couple, you need to plan and prepare, not to guarantee a result, but to open their minds to the vast enormities of the life changes that you are about to experience. This way you will be better prepared and equipped to cope with the challenges and situations that may come your way. You should try to imagine what your life will be like, after the baby arrives, realistically. The pregnancy period is an opportunity for both - the mother and the father, to run through a psychological rehearsal of "life after the birth of baby". Although it is, unrealistic and impractical for the expectant parents to think that, they can strategize for every conceivable scenario related to new parenthood, what so ever it may be, however, they can use the nine months of pregnancy to begin to reflect on how a baby will affect their relationship.